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Obsessive-Compulsive Disorder: What It Is and How to Treat It

Am Fam Physician. 2000 Mar 1;61(5):1529-1530.

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an illness that traps people in endless cycles of repetitive thoughts (obsessions) and behaviors (compulsions). Although we all have habits and routines that help us organize our daily lives, people with OCD develop patterns of behavior that take up too much time and interfere with their daily lives.

Obsessions are unwanted and intrusive ideas, images and impulses that run through the person's mind over and over again. Sometimes these thoughts come only once in a while and are only mildly annoying. At other times the thoughts come constantly and cause great distress.

A compulsion is a behavior that is performed on purpose in response to an obsession. People perform these compulsive behaviors according to “rules” they make up themselves to try to control the nervous feelings that come along with the obsessive thoughts. Sometimes compulsive behaviors are called rituals. For example, a person may have a deep fear of germs and spend hours washing his or her hands after using a public toilet. Rituals like this do make the nervous feelings go away, but usually only for a short while. Then fear and discomfort return, and the person repeats the routine all over again.

Most people with OCD know that their obsessions and compulsions are ridiculous and make no sense, but they can't ignore them.

What are some common obsessions?

These are some common obsessions:

Fear of dirt, germs or contamination

Disgust with bodily waste or secretions

Fear of harming a family member or friend

Concern with order, symmetry (balance) and exactness

Worry that a task has been done poorly, even when the person knows this is not true

Fear of thinking evil or sinful thoughts

Constantly thinking about certain sounds, images, words or numbers

A constant need for reassurance

What are some common compulsions?

These are some common compulsions:

Cleaning and grooming rituals, such as excessive hand-washing, showering and tooth-brushing

Checking rituals involving drawers, door locks and appliances, to be sure they are shut, locked or turned off

Repeating rituals like going in and out of a door, sitting down and getting up from a chair, and touching certain objects several times

Putting items in a certain order or arrangement

Counting over and over to a certain number

Saving newspapers, mail or containers when they are no longer needed

Seeking reassurance and approval

What causes OCD?

OCD may be connected with an imbalance in a brain chemical called serotonin. Serotonin serves as a “bridge” in sending nerve impulses from one nerve cell to the next, and in regulating repetitive behaviors.

How is OCD Treated?

Until recently, OCD has been a difficult illness to treat. However, we now have better medicines. Clomipramine (brand name: Anafranil) helps many people with OCD and usually decreases symptoms to mild levels. Almost everyone has side effects from this drug, such as dry mouth, constipation and drowsiness, and sometimes an inability to achieve orgasm. Fluoxetine (brand name: Prozac), sertraline (brand name: Zoloft), paroxetine (brand name: Paxil) and fluvoxamine (brand name: Luvox) can also help some people with OCD.

Behavioral therapy can be used to lessen unwanted compulsions. First, people are exposed to the situations that produce obsessions and anxiety, and then they are encouraged to resist performing the rituals that usually help control the anxiety. Over time and with practice, OCD symptoms gradually go away. The person with OCD must really want to use this method, though, to be able to tolerate the high levels of anxiety that result.